By completing and submitting this form I hereby authorize Jeffco Public Schools to make the following deduction from my wages. This withholding will begin immediately upon the next qualifying pay check.

I understand that I am supporting the campaign as an "Evergreen Employee" and that to revoke or change this authorization I must submit the revocation in writing to Jeffco Schools Foundation, who in turn will submit to Jeffco Public Schools, Payroll Department, and will become effective after receipt and processing by Jeffco Public Schools for the next qualifying pay check. Payroll deductions submitted by April 12, 2017 will be included as part of the April pay period.

Nothing in this authorization shall be construed to limit the at-will employment relationship between myself and Jeffco Public Schools. For questions email mary.junta@jeffco.k12.co.us